RB but not R-HCVAD is a feasible induction regimen prior to auto-HCT in frontline MCL: results of SWOG Study S1106.

Aggressive induction chemotherapy followed by autologous haematopoietic stem cell transplant (auto-HCT) is effective for younger patients with mantle cell lymphoma (MCL). However, the optimal induction regimen is widely debated. The Southwestern Oncology Group S1106 trial was designed to assess rituximab plus hyperCVAD/MTX/ARAC (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone, alternating with high dose cytarabine and methotrexate) (RH) versus rituximab plus bendamustine (RB) in a randomized phase II trial to select a pre-transplant induction regimen for future development. Patients had previously untreated stage III, IV, or bulky stage II MCL and received either 4 cycles of RH or 6 cycles of RB, followed by auto-HCT. Fifty-three of a planned 160 patients were accrued; an unacceptably high mobilization failure rate (29%) on the RH arm prompted premature study closure. The estimated 2-year progression-free survival (PFS) was 81% vs. 82% and overall survival (OS) was 87% vs. 88% for RB and RH, respectively. RH is not an ideal platform for future multi-centre transplant trials in MCL. RB achieved a 2-year PFS of 81% and a 78% MRD negative rate. Premature closure of the study limited the sample size and the precision of PFS estimates and MRD rates. However, RB can achieve a deep remission and could be a platform for future trials in MCL.

A phase 2 study of Rituximab-Bendamustine and Rituximab-Cytarabine for transplant-eligible patients with mantle cell lymphoma.

Chemoimmunotherapy followed by autologous stem cell transplantation (ASCT) is a standard therapy for transplant-eligible patients with newly diagnosed mantle cell lymphoma (MCL). The achievement of complete remission (CR) and minimal residual disease (MRD) negativity are associated with better outcomes. We tested an induction regimen of rituximab/bendamustine followed by rituximab/high-dose cytarabine (RB/RC). This phase 2 study (NCT01661881) enrolled 23 transplant-eligible patients aged 42-69, of whom 70% were MCL international prognostic index low-risk. Patients received three cycles of RB followed by three cycles of RC. The primary endpoint of the trial was the rate of CR after six cycles of therapy, with a rate of 75% considered promising. 96% of patients achieved a CR/unconfirmed CR after treatment, meeting the primary objective. One patient progressed on study, one declined ASCT in CR, and the remaining 21 underwent successful stem cell collection and ASCT. After a median follow-up of 13 months, the progression-free survival rate was 96%. Among 15 MRD-evaluable patients who completed treatment, 93% achieved MRD negativity after RB/RC. In conclusion, RB/RC achieves very high CR and MRD negativity rates in transplant-eligible patients, with a favourable safety profile. RB/RC warrants further comparative studies, and may become a useful alternative to RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)-based induction regimens in this patient population.

Linking vegetable preferences, health and local food systems through community-supported agriculture.

OBJECTIVE: The objective of the present study was to explore the influence of participation in community-supported agriculture (CSA) on vegetable exposure, vegetable intake during and after the CSA season, and preference related to locally produced vegetables acquired directly from CSA growers. DESIGN: Quantitative surveys were administered at three time points in two harvest seasons to four groups of CSA participants: new full-paying, returning full-paying, new subsidized and returning subsidized members. Questionnaires included a vegetable frequency measure and measures of new and changed vegetable preference. Comparisons were made between new and returning CSA members and between those receiving subsidies and full-paying members. SETTING: The research was conducted in a rural county in New York, USA. SUBJECTS: CSA members who agreed to participate in the study. RESULTS: Analysis was based on 151 usable questionnaires. CSA participants reported higher intake of eleven different vegetables during the CSA season, with a sustained increase in some winter vegetables. Over half of the respondents reported trying at least one, and up to eleven, new vegetables. Sustained preferences for CSA items were reported. CONCLUSIONS: While those who choose to join a CSA may be more likely to acquire new and expanded vegetable preferences than those who do not, the CSA experience has the potential to enhance vegetable exposure, augment vegetable preference and increase overall vegetable consumption. Dietary patterns encouraged through CSA participation can promote preferences and consumer demand that support local production and seasonal availability. Emphasis on fresh and fresh stored locally produced vegetables is consistent with sustainable community-based food systems.

The effects of school gardens on fruit and vegetable consumption at school: A randomized controlled trial with low-income elementary schools in four U.S. states.

This randomized controlled trial examines the effects of a school garden intervention on children's fruit and vegetable (FV) consumption at school over two years. We randomly assigned schools to the intervention group that received gardens and related curriculum (n = 24) or to the waitlist control group that received gardens and curriculum at the conclusion of the study (n = 22). Children in second, fourth, and fifth grade at baseline (n = 2767) in low-income schools (n = 46) in four U.S. States (Arkansas, Iowa, New York, and Washington) participated. The intervention comprised gardens for each classroom; a curriculum focused on nutrition, plant science, and horticulture, including activities and FV tasting sessions; resources for the school that addressed topics such as soil contamination and food safety; an implementation guide focused on issues related to planning, planting, and maintaining the garden through the year, engaging volunteers, summer gardening, building community capacity, and sustaining the gardening program. FV consumption was measured by photographing lunches before and after children ate, for 2-3 days, at baseline and at each of 3 subsequent periods of data collection during the intervention. FV consumption was calculated using Digital Food Image Analysis. Among children in the intervention, fruit consumption and low-fat vegetable consumption increased from pre-garden baseline to post-garden more than among control group children. Garden intervention fidelity (GIF) also predicted changes in dietary intake, with more robust interventions showing a stronger effect than weaker interventions. GIF-lessons was a particularly potent predictor of change in dietary intake. School gardens modestly increase children's FV consumption at school.

High-throughput, high-accuracy array-based resequencing.

Although genomewide association studies have successfully identified associations of many common single-nucleotide polymorphisms (SNPs) with common diseases, the SNPs implicated so far account for only a small proportion of the genetic variability of tested diseases. It has been suggested that common diseases may often be caused by rare alleles missed by genomewide association studies. To identify these rare alleles we need high-throughput, high-accuracy resequencing technologies. Although array-based genotyping has allowed genomewide association studies of common SNPs in tens of thousands of samples, array-based resequencing has been limited for 2 main reasons: the lack of a fully multiplexed pipeline for high-throughput sample processing, and failure to achieve sufficient performance. We have recently solved both of these problems and created a fully multiplexed high-throughput pipeline that results in high-quality data. The pipeline consists of target amplification from genomic DNA, followed by allele enrichment to generate pools of purified variant (or nonvariant) DNA and ends with interrogation of purified DNA on resequencing arrays. We have used this pipeline to resequence approximately 5 Mb of DNA (on 3 arrays) corresponding to the exons of 1,500 genes in >473 samples; in total >2,350 Mb were sequenced. In the context of this large-scale study we obtained a false positive rate of approximately 1 in 500,000 bp and a false negative rate of approximately 10%.

Differences in Maternal Risk Factors Among Undocumented Latinas in Nebraska by Country of Origin.

OBJECTIVE: This study compared maternal risk factors by country of origin for 4,188 Mexican and Guatemalan unauthorized immigrants. METHOD: Data were drawn from 2007 to 2011 public birth certificate records of unauthorized immigrant mothers residing in Nebraska at the time of delivery. The study sample included 4,188 women ages 18 years or older and originating from either Mexico or Guatemala. Risk factors, including age risk, preexisting health risks, pregnancy health risks, and prior pregnancy risks, were examined by country of origin. Stata 11.0 was used to compute descriptive statistics and conduct χ2 test for binary variables and Student t test for continuous variables. RESULTS: Analyses found that Mexican and Guatemalan participants have distinct maternal risk factors. Mexican participants were older and at greater risk of obesity and excessive weight gain during pregnancy, while Guatemalan participants were more likely to receive inadequate prenatal care. CONCLUSION: Findings suggest that both Mexican and Guatemalan immigrants encounter maternal risk factors that could threaten not only their own health but that of their infants as well. Health and social service providers can tailor education and outreach efforts that are specific to Latina subgroups by origin. Furthermore, targeted strategies to delivering prenatal care to unauthorized immigrants are essential for the well-being of mothers and newborns.

Use of a risk communication model to evaluate dietetics professionals' viewpoints on genetically engineered foods and crops.

The complex issues surrounding the application of genetic engineering to food and agriculture have generated a contentious debate among diverse interest groups. One pervasive dimension in the resultant discourse is the varying perceptions of the risks and benefits of genetically engineered foods and crops. In the risk communication model, technical information is evaluated within the context of an individual's values and perceptions. The purpose of this study was to explore how dietetics professionals respond to a complex set of interrelated issues associated with genetically engineered foods and crops and to identify what varying viewpoints may exist. Participants were asked to sort a total of 48 statements distributed across eight issue areas according to level of agreement and disagreement. Using Q methodology, a total of 256 sortings were analyzed using the centroid method and varimax rotation in factor analysis. Three distinct viewpoints emerged: Precautionary (R(2)=43%), Discerning Supporter (R(2)=11%), and Promoting (R(2)=5%). Across all viewpoints, respondents agreed that dietetics professionals should employ critical thinking skills to communicate the social, economic, environmental, ethical, and technical aspects of genetically engineered foods and crops. The findings have implications for how dietetics professionals can foster an open interchange of information among diverse groups.

Use of a participatory planning process as a way to build community food security.

The purpose of this study was to determine the multiple meanings of community food security among stakeholders with diverse interests and to assess the degree to which these stakeholders could find common ground around community food security during a participatory planning process called a search conference. The conceptual framework of citizen politics guided all aspects of the research design. In-depth, qualitative interviews were conducted with 44 participants purposefully recruited to attend a 2 1/2 h-day search conference. Open-ended questionnaires were distributed to all participants during the search conference, and a document review was performed. Prior to the search conference, 4 community food secruity groups emerged: anti-hunger advocates (n=12), agricultural visionaries (n=12), food traditionalists (n=10), and agricultural entrepreneurs (n=8). Participants were able to find common ground around 6 community food security action agendas: distribution of surplus food, education, family and community values, food processing and marketing, legislative initiatives and action, and new agriculture. Other salient community food security issues emerged, but they were not included on any of the action agendas. Formal training in facilitation, negotiation, conflict resolution, and how to influence the public policy-making process will enable dietetics professionals to effectively collaborate with community-based groups that have a stake in food security issues.

Mechanisms of power within a community-based food security planning process.

A community food security movement has begun to address problems of hunger and food insecurity by utilizing a community-based approach. Although various models have been implemented, little empirical research has assessed how power operates within community-based food security initiatives. The purpose of this research was to determine how power influenced participation in decision-making, agenda setting, and the shaping of perceived needs within a community-based food security planning process, with particular reference to disenfranchised stakeholders. Power influenced participation in decision-making, agenda setting, and the shaping of perceived needs through managing 1) problem framing, 2) trust, 3) knowledge, and 4) consent. To overcome these mechanisms of power, practitioners need to address individual-, community-, and institutional-level barriers to participation in community-based food security planning processes. Practitioners and researchers can work with disenfranchised groups to determine which agents have the power to create desired changes by utilizing theory-based methods and strategies that focus on changing external determinants at multiple levels.

Agenda setting within a community-based food security planning process: the influence of power.

OBJECTIVE: To determine the effectiveness of using citizen politics as a framework for empowering citizens to build a community food security agenda. DESIGN: A critical perspective, case study design, and multiple qualitative methods were used. PARTICIPANTS/SETTING: Forty-four participants were purposefully recruited to participate in a community-based planning process called a search conference (SC). Seven additional disenfranchised stakeholders who did not attend the SC were also recruited to participate. PHENOMENON OF INTEREST: To assess how power influenced agenda setting and to determine the extent to which disenfranchised stakeholders' most salient interests were incorporated into the final SC action agendas. ANALYSIS: The constant comparison method, content analysis, and consensus were used to produce the final analysis. RESULTS: Power influenced agenda setting by managing knowledge, problem framing, trust, and consent. Two of seven of disenfranchised stakeholders' most salient interests, including need for adequate food preparation skills and increased availability of locally produced foods, were incorporated into the final SC action agendas. CONCLUSIONS AND IMPLICATIONS: Citizen politics can be used to build a community food security agenda on issues that are not at odds with stakeholders in positions of power. To bring about change on issues in which power differences between groups are substantial, additional theoretical frameworks and public policy-making models are needed.

Academy of Nutrition and Dietetics: Standards of professional performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems.

Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems.